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• \ <br />10. <br />11. <br />OR <br />12. <br />13. <br />0Completed by: 14. <br />Signature Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />l; <br />Bleach and WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler i <br />TEMP EVENT APRPage 8 of 11 <br /> Refrigerated truck <br /> Other (specify) <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off oi the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8, water for <br />storing wiping doths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45^0Ffood is used the following day, maintain below 41°F temperature): <br />□Ice chests Refrigerator <br /> Ice bath and tubs <br />Sterno w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />□A/Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />( Extra \ <br />I Waler <br />Rinse Water <br />□'One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />towels and pump-style soap container. <br />Propane Tank <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />n 11 I EMr EVEN I AlEHD 16-02 Page 8 of 11 <br />06/29/2023 <br />vn I t j r-\ vy w i i i <br />------COUNTY------- <br />‘‘important** <br />Names of responsible pmsible persons^ to be present in booth during all hours of operation: , > J ________________ <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this evei <br />Date <br />I am Dreading the following items within my booth for the sanitary cleaning of food preparation utensil <br />□'Three compartment sink. <br />□"Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solutibn (pne tablespoon of bleach per gallon of water). <br /> Dptdrgent, bleach, and wiping cloths (cleaning towels). <br />□Tub to store wiping cloths in bleach solution.